Predicting tumor recurrence using metabolic indices of 18F‑FDG PET/CT prior to orthotopic liver transplantationfor hepatocellular carcinoma

Abstract

The present study analyzed the ability of metabolic burden indices from 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) to predict tumor recurrence following orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC). Seven major metabolic indices were measured by 18 F-FDG PET/CT in 93 patients with HCC, prior to OLT. The Mann-Whitney U test was then used to predict the association of metabolic indices, including the maximum standardized uptake value (SUVmax), tumor-to-mediastinum SUV ratio, tumor-to-normal-liver SUV ratio, SUV normalized to lean body mass metabolic tumor volume (MTV), total lesion glycolysis (TLG) and uptake-volume product (UVP), with the recurrence risk. The Deauville-like scoring system was used to quantify the recurrence risk. Univariate and multivariable Cox regression models were performed to determine survival rate. The results showed that Deauville-like score (PET-negative vs.-positive), MTV (cutoff value, 13.36), TLG (cutoff value, 62.21) and UVP (cutoff value, 66.60) had high prediction performance for tumor recurrence (P<0.05). TLG had the highest receiver operating characteristics area under the curve of 0.725. Among the clinical factors, high level of α-fetoprotein (AFP, ≥144 ng/ml), Milan criteria, tumor number (>3), involvement of both right and left lobes, and tumor size (>5 cm) were found to be significant predictors of tumor recurrence. Patients in the low metabolic group had longer recurrence-free survival (RFS) times compared with those in the high metabolic group, regardless of whether they met the Milan criteria or not. AFP, uptake-volume product according the SUV mean of mediastinum (UVP-M), Milan criteria, lymph node metastasis, and the number of tumors were significant prognostic factors for RFS (P<0.05) in both univariate and multivariate survival analyses. Additionally, the MVI was a significant prognostic factor based on univariate survival analyses. Overall, the present study demonstrated the metabolic burden indices measured by PET/CT, Deauville-like score, MTV, TLG and UVP as significant prognostic factors in patients with HCC following OLT. The combination of metabolic indices measured by PET/CT and the existing criteria, such as the Milan criteria, may play an important role in evaluating the suitability of OLT in specific patients.

The Landscape Of Alpha Fetoprotein In Hepatocellular Carcinoma: Where Are We?

“…Some novel indicators have been investigated for integration with AFP, such as 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) 131,132 and plasma metabolomics profiling 133 . In addition, several criteria established and validated previously were combined with AFP for the purpose of minimizing the risk of post-LT tumor recurrence 134,135 .…”

Metabolic tumor volume predicts long-term survival after transplantation for unresectable colorectal liver metastases: 15 years of experience from the SECA study

“…However, MTV from the pre-treatment 18 F-FDG PET/CT has shown to be prognostic in patients treated with selective internal radiation therapy (SIRT) with yttrium-90 for unresectable CRLM and resection for CRLM [ 24 – 27 ]. Several studies have shown that MTV derived from 18 F-FDG PET/CT can predict recurrence and survival after LT for HCC [ 28 , 29 ].…”

Preoperative Radiomics Analysis of Contrast-Enhanced CT for Microvascular Invasion and Prognosis Stratification in Hepatocellular Carcinoma

“…It has been shown previously that tumor number positively related to the incidence of MVI, and frequency of MVI dramatically increased as tumor number increased. [26][27][28] Elevated AST level has been investigated as a detrimental factor on prognosis for HCC patients, which reflects liver burden and may indicate anti-aggressiveness of liver to some extent. 29,30 To our knowledge, few studies found AST as an independent predictor of MVI, AST was identified as independent predictor of MVI for HCC patients in our current study.…”